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1103 Williams Rd ' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION J 0 ; ,3 0 *NOTEAssued incompliance With Article Il of G.S.Chapter 130a Sanitary Sewage Systems Permit. Number Name �� cz\ ��.�� t� Date ,-� ' '1 Q N_ . Location 1ti -; \� ,4 l h ` c�. �� c.<, r)l 0 U b C"t,Lw k Subdivision Name Lot No. ec. Lot Size 'House Mobile Home L..f Business Speculation No. Bedrooms No. Baths— No. in Family Garbage Disposal YES ❑ NO E]% Specifications for System: Auto Dish Washer YES ❑ NO ,p' Auto Wash Ma:hive YES (p' NO ❑ Type Water Supply V0 *This,permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans orrthe intended use change. _ Improvements permit by 4 -».^.r..N.-..+--..., ...........:..._.«.Ww...,..,.........,-.--.. _'.."'..."'..yam_-. *Contact a representative of the Davie County Health Department for final inspection o this System between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985. , f' S Final Installation Diagram: System Installed by Certificate of Completion `� 4 Date ��– "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way betaken as a guarantee that the system will function satisfactorily for any given period of time. + APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department • G ��11 Environmental Health Section P. 0. Box 665 Mockoville, NC 27028 1 . Application/Permit Requested By 00-0 Al d �f/NiER Mailing Address es ,gox 0265-B zgoldANcc, Al, C• 2 700 Home Phone -9'7,9- 70-31 Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: General Evaluation PDX /Tank Installation S. System to Serve: 0 House poolgobile Home Q Business D Industry u Other lf n 0 Unknown 6. If house, mobile home: Subdivision , iY7� Sec. Lott No. of People Dwelling Dimensions .-6 X 1411 No. of Bedrooms 2 Basement/Plumbing No. of Bathrooms / Basement/No Plumbing (Washing Machine J Dishwasher Garbage Disposal 7. If business, industry, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers 8. Type of water supply: 014 � /(f0Utj Private a Community 9. Property Dimensions ,A Cgc 10. Sewage Disposal Contractor gyd;A/ 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? o Yes 2--No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change . Effective October 1, 1989. This is to certify that the information provided is correct to tree best of my knowledge, and I understand I am responsible for all charges- incurred from this application. d- -s'IF/ Date Signature PAflo Fuon+ /rloc Ksv.LLE fo FoRK C'o•��nuv;fy - ?vlz&j )E Ft /3e51dc FoRA' fiXcS1/9, dN FO/Z k-XxbJ Rd- Gu 0(na' 21";lr-s fo 6fLJL;,4-, Rd- Tyony Lei:-t- InobJlc- llomE bL-h1id Directions to Property : anrd belce fiovs rs o v JQJ� DCHD (10-89) v DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS S Q-M 9- PROPERTY SIZE \�.-` � PROPOSED FACIILTY _ \`\� a � LOCATION OF SITE W aS� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S .5 S Sloe % 0 -ts° 0 .%d HORIZON I DEPTH Texture group L 5 L- Consistence F-T H Structure C MineralogX ► ', l' l 1 .F I',1 HORIZON II DEPTH LAr Texture groupC C C G Consistence Structure RFK A '. 43 t_- Mineralogy _-Mineralo '►1 ', l I : 1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS s RESTRICTIVE HORIZON — -• SAPROLITE — CLASSIFICATION 5 S S LONG-TERM ACCEPTANCE RATE ,5S - ,0 1'3-'- , A -, () SITE CLASSIFICATION: S EVALUATED BY: �C LONG-TERM ACCEPTANCE RATE: 4) OTHER(S) PRESENT: REMARKS: C-),- 5�4� — LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1, 2:1. Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon- Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water' or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 ■■.wew■www.■w.■wwaww■■e..■.■■.■■■■..ww...■■....■��lw.wew.w.�iw;�■w�■w■ ■■■■■■■■■■■■■■■■■■■■■■U/■■■■■/■■■■■■■■■■■■■■■■■lII1111■■■■■■■■■I■Y.,X■■■■ ■............■......■■.■...1'I►1■■.■.■.■III.■....■.■lw.11�l.Y...■.w..Il...■ ■■.■■■■■.■■■■.■■■....■!I■■.■■■.■■■.■■■■■■■■.■■■It■ 111/■...■■I■./1..■■■ ■wwwe.■ww■ewe.■.■■ww■■■.■e......■...w.w..■.w........■ ■■■ ■......■ ■■w.e=ww■wwe■■■e■w■w■■w■w■www■■■■■■sw■we.w.w■=ew...■■■�.■wl�iw■e■w■■■ ■...e ■w■w.w.■■w■we■w■■w■e..w■wweww..w■.■ww.■ ■w.ww■■ew.wrwwew...■ ■■■■e.wwwwwww■w■■■■■■■■■■■ww■w■ww■■■w■www■■■■we.ww..wew■ww..■.ww.■ =iiiiiiiiiiiiiiiieiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiil■iiiiiiii:iiii ■w.we.w■ ww■.www■we .w.■www.w.■wewwwww.e.ww.■■e.ww.w.e.w..w.■w.ww■ .............. ................■.................................. .................................................................. ■■■.......w■■.ww.we..w...eww.w.■■........■..■....w....■■w.w■■■.ww■ UiiiiiiiiiiiiMENNEN EMiiii�' IMENNENiiii■iN MENNEN MENNEN ■..■..ww■■.....■■we■■..■.■■.■■w..■■■w..e.ww.■■e.w....ww..w■.w...w■ ■■■■w■■www.ew■■..■e■..■■■e.■■■wwww.■■..ew..w...w■■■■.w..■.w.ww..w■ ■■■■.■■www■■eww.■■e..■t.■e....■■e■ww.■.■ww■■....ww..w■.....■.....■ ■..w..ww■www■..■e■ww..■.....■w.■■..■...■...w..w..w.■w..ww.■■w....■ ■■www■w.■.■■...■■we.■..■■■...w.■■.■■ww.w...ww.w..e.■..■■www..wee.■ ................................................................. .........................■..............................■....■■... ........■......................................................... .................................................................. ■■■ww■■e■■■w■■■■■w...■www....■■■.■■■.......w■....w...■■..■■.w....■ n■■■■.■ ■...■■....■■■■■■■..■e■■■■■■■■■■■■.■■■.■..■....■.■■■.■/■.■■